Outcomes of Biodegradable Temporizing Matrix for Soft Tissue Reconstruction of the Hand and Extremities

Abstract

Background: NovoSorb biodegradable temporizing matrix (BTM) is a novel, bilayer, synthetic skin substitute made of biodegradable polyurethane foam covered with a sealing membrane. BTM has demonstrated excellent outcomes in burn literature; however, few studies have been published for hand and extremity soft tissue reconstruction.

Methods: All patients who underwent extremity reconstruction with BTM from 2018 to 2023 were reviewed. Demographics, presentations, and clinical outcomes were recorded.

Results: A total of 86 cases from 54 patients (53.7% pediatric; age range: 0-81 years) were included. Common indications included trauma (36%), infection (18.6%), and malignancy (11.6%). BTM was placed over exposed tendon (38.4%), bone (19%), joints (12.8%), nerves (8.1%), and/or blood vessels (7%). BTM served as temporary wound coverage in 26 cases. Complications included hematoma (8.1%), infection (4.7%), and spontaneous delamination (4.7%). Wound closure was successfully obtained without flap use in 93.3%. Poor BTM take was associated with peripheral vascular disease, hypertension, immunosuppression, and BTM hematoma and infection (<0.05).

Conclusion: This study contributes to the growing body of evidence favoring BTM use in challenging reconstructive cases. Although prospective comparative studies are forthcoming, BTM likely has broad applications in reconstructive surgery.

Fig. 1.

This figure corresponds to a case of lower extremity necrotizing fasciitis in a 16-year-old male patient. A, The patient’s soft tissue deficit over the left leg. The defect area was too large for flap coverage, and skin grafting may have limited range of motion over the knee. B, The patient immediately after BTM placement. C, The patient 10 months after reconstructing with BTM and STSGs. The patient has full range of motion and resumed sporting activities without any functional deficits. See supplemental videos for more details. Printed with permission from and copyrights retained by Shaun D. Mendenhall, MD.

Fig. 2.

Photograph showing an 81-year-old patient who had invasive squamous cell carcinoma of the dorsal hand. A, The squamous cell carcinoma before resection. B, The defect after malignancy excision. C, BTM after 4 weeks, immediately after delamination. Note the vascularization of the wound bed. D, Seven months (33 wk) after skin graft. Printed with permission from and copyrights retained by Shaun D. Mendenhall, MD.

Fig. 3.

Photograph of an upper extremity case of a 36-year-old woman who had necrotizing fasciitis with exposed tendons. BTM and STSG mitigated the need for free flap coverage and restored important ROM for this patient. A, The patient’s wound after final debridement. The extensor mechanism over the metacarpals was exposed with minimal paratenon. B, The wound immediately after placing BTM. C, The patient’s dorsal hand and forearm 16 months after skin grafting. The patient has near full extension and flexion at the metacarpophalangeal joints and wrist. See supplemental videos for more details. Printed with permission from and copyrights retained by Shaun D. Mendenhall, MD.

Fig. 4.

Photograph of a lower extremity case of a 21-year-old man who had an exposed tarsometatarsal joint after a side-by-side utility-terrain vehicle accident. A, The patient’s injury at presentation. B, The wound after placing BTM. C, The wound 5 months after STSG. Printed with permission from and copyrights retained by Shaun D. Mendenhall, MD.